Assisted dying – ethical challenges

By Savi Hensman

January 6, 2012

Assisted suicide should be legalised for terminally ill people, according to the Commission on Assisted Dying, chaired and funded by advocates of legalising assisted dying. No doubt a commission set up by opponents would come to a contrary conclusion. Some will applaud the strict conditions proposed, others fear that such measures would in time lead to euthanasia on a wider scale.

The debate raises difficult ethical issues. On the one hand, the importance of autonomy is widely acknowledged; and it might seem unfair that those who are physically capable of committing suicide have an advantage over others. On the other hand, humans are social animals, and feeling that dying would be best does not happen in a vacuum.

For instance, victims of domestic violence or bullying in schools and workplaces, or those who have lost the person whom they most loved in the world, may (maybe fleetingly) wish they were dead. This may be worsened if it seems that society is hostile and judges one to be of little worth.

Even today in the West, for example, sizeable numbers of young lesbian, gay, bisexual and trans people attempt suicide. Things seem so bleak that, for a while, death appears to be the best option. Racism too can drive young people to the brink of suicide. Few people, however ignorant and insensitive, would argue that those old enough to choose should be offered expert assistance to kill themselves. A better response is to try to persuade despairing young people that “it gets better”, and tackle discrimination.

Elderly and disabled people in Britain often face severe prejudice and harassment. When one watches the abuse of young people with learning disabilities in Winterbourne View hospital, or reads about disturbing levels of hate crime against disabled people overall, it is not surprising that life can seem unbearably grim. Elder abuse too is common.

Worse still, much of the mistreatment is system-based, not simply the fault of individuals. People are left in avoidable pain and squalor because too few trained and qualified staff are present in hospitals, care homes and community settings, or because inspectors’ ability to enforce high standards has been undermined by government.

Nurses “weren’t unkind to him, but they were overworked...he was a very fastidious man and he really was left lying in his own excrement,” a patient’s sister-in-law told the Mid Staffordshire hospital inquiry. Careworkers “were supposed to feed and give drinks but simply left them beside a person who was physically unable to feed herself” because they “had to go to their next client. My mother went down to seven stone,” the Equality and Human Rights Commission heard. Death should not be the only relief on offer.

Extreme cost-cutting measures when contracting out care have worsened the problem and, as the NHS increasingly outsources services such as district nursing, the problem may get worse.

Though there have been great strides in pain relief and palliative medicine, and basic care delivered in an unhurried and respectful manner can do much for people’s physical and emotional wellbeing, many sick people do not get such help consistently. They are left hungry, thirsty, dirty, in pain, bewildered or humiliated. The government may claim adequate care is unaffordable – but billions are squandered on repeated reorganisations of NHS and other services, waging wars and unwillingness to pursue the super-rich and large corporations for tax revenue.

The Commission on Assisted Dying has stated a good level of care and support services is necessary. However, unless there is a radical change, many patients will remain justifiably afraid of inadequate care, and this will affect their choices.

Meanwhile politicians and journalists are fuelling suspicion and hatred of disabled people of working age, encouraging even those are seriously ill to be viewed as “scroungers”, and subjecting them to “tests” which leave many feeling suicidal.

If legalisation went ahead under current conditions, apart from the risk of undue pressure from relatives, sick people would in effect face the threat of systemic abuse if they did not opt to die. Some might have chosen death anyway, but it would be impossible to distinguish them from those who might have preferred to live if proper care and respect were guaranteed.

At the same time, refusing to grant sick people’s requests to die might seem harsh if it means that they will continue to suffer in a cruelly discriminatory society. Until attitudes to, and treatment of, frail older and disabled people change radically, the assisted dying debate will involve two less-than-desirable alternatives.

Some involved in this controversy also campaign for the human rights of frail older and disabled people to be respected. It would be good if more joined in, from both sides.

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(c) Savitri Hensman is a Christian commentator and Ekklesia associate.

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